Foundations in

Medical Microbiology
Prof. Yuwono
Departemen Mikrobiologi FK
Unsri/RSUP Dr. Moh. Hoesin
Palembang
Microbe-Human Interactions:
Infection and Disease
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• Infection- a condition in which
pathogenic microbes penetrate host
defenses, enter tissues & multiply
• Disease – any deviation from health,
disruption of a tissue or organ caused by
microbes or their products

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 Resident flora
• includes bacteria, fungi, protozoa, viruses and
arthropods
• most areas of the body in contact with the outside
environment harbor resident microbes; large
intestine has the highest numbers of bacteria
• internal organs & tissues & fluids are microbe-free
• bacterial flora benefit host by preventing
overgrowth of harmful microbes

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Landscape of the skin

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Colonized regions of the respiratory
tract

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• True pathogens – capable of causing disease in
healthy persons with normal immune defenses
– Influenza virus, plague bacillus, malarial
protozoan
• Opportunistic pathogens – cause disease when the
host’s defenses are compromised or when they
grow in part of the body that is not natural to them
– Pseudomonas sp & Candida albicans

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Overview of infection

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 Virulence factors
• exoenzymes – digest epithelial tissues & permit
invasion of pathogens
• Toxigenicity – capacity to produce toxins at the
site of multiplication
– endotoxins – lipid A of LPS of gram-negative bacteria
– exotoxins – proteins secreted by gram-positive and
gram-negative bacteria
• antiphagocytic factors – help them to kill or avoid
phagocytes, include leukocidins and capsules
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 Patterns of infection
• localized infection– microbes enters body &
remains confined to a specific tissue
• systemic infection– infection spreads to
several sites and tissue fluids usually in the
bloodstream
• focal infection– when infectious agent
breaks loose from a local infection and is
carried to other tissues

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 Patterns of infection
• Mixed infection – several microbes grow
simultaneously at the infection site
• Primary infection – initial infection
• Secondary infection – another infection by a
different microbe

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Portals of exit

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 Koch’s postulates
1. Find evidence of a particular microbe in every
case of a disease
2. Isolate that microbe from an infected subject and
cultivate it artificially in the laboratory
3. Inoculate a susceptible healthy subject with the
laboratory isolate and observe the resultant
disease
4. Reisolate the agent from this subject

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 POLA KUMAN &
KEPEKAANNYA TERHADAP
ANTIBIOTIK
Leading global infectious diseases
S. pneumonia: Up to 55%
resistance to penicillin in S. dyentariae: 90% resistance to
some regions cotrimoxazole S.Typhi: Outbreaks of
multi-resistant strains in 11 countries

HIV: Report of
resistance to all
M. tuberculosis:
marketed agents
Multi-drug resistant
tuberculosis

P. falciparum:
Chloroquine resistance in
81/92 countries
 Classification of Antibiotics

• Bacteriostatic • Bactericidal
 What are Multi-Drug Resistant
Organisms? (MDROs)

• MDROs are microorganisms, predominantly bacteria, that are

resistant to one or more classes of antimicrobial agents
– Examples of MDROs (not all inclusive)
• Methicillin-resistant staphylococcus aureus (MRSA)
• Vancomycin-intermediate staphylococcus aureus (VISA)
• Vancomycin-resistant staphylococus aureus (VRSA)
• Vancomycin-resistant enterococcus (VRE)
• Streptococcus pneumoniae resistant to penicillin and other
broad-spectrum agents
 What are Multi-Drug Resistant
Organisms? (MDROs)

– Other Examples of MDROs

• Some gram-negative organisms with strains that have
developed the ability to produce ESBL (extended-
spectrum beta-lactamase) which is an enzyme that
inactivates beta-lactam antibiotics such as the penicillins
and cephalasporins
– Klebsiella pneumonia
– Escherichia coli (E. Coli)
– Acinetobacter baumannii
– Stenotrophomonas maltophilia
 Phenotypic Testing for KPC Production:
Modified Hodge Test

Local KPC +
Enterobacter Cloacae
isolate tested at ETSU
Microbiology Lab,
Courtesy picture by
Dr. Donald Ferguson
2/2010

Anderson et al. J Clin Microbiol 2007; 45: 2723–25.

TERIMA KASIH